Implementation of ECLS:
Veno-arterial (V-A): Blood is removed from the veins of the body and oxygenated. Pressurized oxygenated blood is returned to the body via the arterial system thus replacing the function of the heart and lungs. This is also known as cardiopulmonary bypass (CPB).
Veno-venous (V-V): Used in isolated respiratory failure, dark blood is removed from the venous circulation, oxygenated and returned to the venous system closer to the heart. This ECMO mode replaced or supplements the function of the lungs and does not provide cardiac support. This mode of support is also known as extracorporeal lung support (ECLA) or extracorporeal CO2 removal (ECCOR).
Initiation of ECLS:
- The patient receives pain and sedation medication.
- The patient is given a drug (muscle relaxant) to keep him/her from moving or breathing. This keeps the patient from accidentally dislodging the cannulas.
- A small cut (incision) is made in the neck or groin and the cannulas is put in place. In some cases, the chest may be opened so that the cannulas can be placed directly in or near the heart. For some patients, the cannulas is placed through the skin, meaning no incision is made.
- The cannulas is connected to the ECMO circuit, which is filled with blood or fluid – depending on the needs of the individual.
- The machine is turned on the ECMO flow set. At this point, the patient is on ECMO.
Within two to three days after ECMO initiation, the team will coordinate a family meeting to discuss the plan of care and outline the actions needed for the duration of ECMO support.
For assistance in facilitating transfers to Ronald Reagan UCLA Medical Center, contact the UCLA Health Transfer Center at 310-825-0909